Steroids May Increase Risk of Cardiac Disease, Research Finds

A new study published in the journal PLOS Medicine found that glucocorticoids, a type of steroid medication, increase the risk of cardiovascular disease in some individuals.

Previous research had shown that the lowest doses of steroids did not impact cardiovascular risk. However, this recent study, published on December 3, concluded that cardiovascular risk nearly doubles in patients who take low-dose steroids and increases even further in patients who take higher doses over extended periods of time.

Researchers reviewed 87,794 medical records from the U.K. between 1998 and 2017. Patients in the analysis had received steroids for at least one of the following conditions: giant cell arteritis, polymyalgia rheumatica, inflammatory bowel disease, lupus, rheumatoid arthritis, or vasculitis. The average subject age was 56 years, and 34% were men.

Some of the cardiovascular events these patients experienced include:

• Heart attack
• Heart failure
• Atrial fibrillation
• Peripheral arterial disease
• Stroke
• Abdominal aortic aneurysm

Weighing the Benefits and Risks of Steroid Use

Glucocorticoids are a type of steroid used to treat conditions associated with inflammation. Many transplant recipients take glucocorticoids to prevent organ or tissue rejection. Short-term use of glucocorticoids can help patients with allergic reactions, asthma, and COPD flare-ups. They help regulate metabolic, immune, and inflammatory processes in the body.

For patients whose condition requires long-term steroid use, it is essential to have a conversation with your prescriber about your treatment plan’s risks and benefits.

“The patient and physician should have a discussion," Sonal Chandra, MD, a board-certified cardiologist and assistant professor with the department of internal medicine at Rush Medical College in Illinois, tells Verywell. "Ask ‘How long do I need to be on this? Is there a plan to lower the dose?' It’s important for patients to understand why the steroid is necessary and to monitor their response to it.”

It is also vital to consider that there are potential risks to not treating underlying immune conditions.

“Long-term steroid use is associated with increased risk for obesity, diabetes, high blood pressure, cholesterol issues, and also heart attack and stroke," Nicole Harkin, MD, a board-certified cardiologist based in California, and Whole Heart Cardiology founder, tells Verywell. "However, for many patients, steroids are required to control an autoimmune condition. We also know that uncontrolled autoimmune conditions are associated with increased risk for heart attack and stroke, likely due to high levels of underlying inflammation.”

According to Chandra, who is also the director of the CardioMetabolic Program at Rush Medical College, women have an overall lower risk of heart disease, but their risk begins to approach men if they take steroids long term or enter menopause prematurely.

“Based on the available evidence, it’s unclear how much damage is done by the glucocorticoids versus the underlying condition itself,” Aaron Emmel, PharmD, founder and director of the Pharmacy Tech Scholar program who is based in Florida, tells Verywell. “This does not mean you shouldn’t use these drugs, but you need to look at the big picture and make sure that all the other risk factors for cardiovascular disease are addressed. The benefits of receiving steroids could still outweigh the risks of not managing the underlying condition.”

“All of these problems appear to be dose and duration-dependent,” Emmel adds. “Prescribers should use the lowest effective dose for the least amount of time possible.”

For patients who must be on glucocorticoids long-term, Chandra advises discussing the risks and benefits of the medication, along with lifestyle and cardiovascular risk factor modification.

“Is important to take a multidisciplinary approach to steroid use," Chandra says. "Steroids can be lifesaving and provide a significant amount of relief, but they can have serious sequelae. For patients who have to take long term low dose steroids, it’s better to understand the risks and address them one by one.”

How to Lower Cardiovascular Disease Risk

“All [patients on long term steroids] should meet with a preventive cardiologist or internist to work on treating and eliminating other risk factors to lower their risk of heart disease with aggressive lifestyle changes and medicines if needed,” Harkin says.

Chandra recommends the following lifestyle and risk factor modification strategies for all patients:

• Exercise regularly
• Eat a diet rich in fiber, whole grains, fruits, and vegetables and low in processed sugar, saturated fat, and salt
• Routinely monitor blood pressure, blood sugar, and lipids, medicating as needed
• Quit smoking

Chandra also suggests reaching out to your healthcare provider to focus on your concerns, adding that providers can address many of these issues in a virtual visit. “If the patient comes in knowing that they want to talk about their risk factors for heart disease, then it is more realistic that it is going to get addressed," Chandra says.

Are There Alternatives to Steroid Therapy?

Some patients may benefit from alternatives to steroid therapy, such as new biologic response modifying drugs, which target the immune system’s inflammatory response. Biologic response modifiers are beneficial drugs for many patients, but they also have drawbacks to consider.

“Biologic response modifiers have problems, the most common of which is suppressing the immune system, which glucocorticoids also do,” Emmel says. “They also tend to be costly, which glucocorticoids are not.”

“I encourage patients to speak with their physician about alternative treatments to glucocorticoid therapy,” Chandra adds. “There isn’t a completely safe option because every medication has the potential to cause side effects, but it’s worth it to have a discussion with your physician about what the other options are so the patient feels informed.”

Chandra reiterates that a discussion with your doctor is the best way to tailor treatment to your specific needs.

“We have decades of research on glucocorticoids," Chandra says. "The long-term data about biological modifiers are coming out, and we do not see a higher propensity for cardiovascular risks. Still, some biologics can do some harm in those individuals. We need to have multidisciplinary discussions, including all the providers involved in a patient’s care.”